title: Nonthyroidal illness syndrome in enterocutaneous fistulas.
abstract: BACKGROUND
  The aim of this study was to investigate the incidence, etiology, clinical outcomes, and prognosis of nonthyroidal illness syndrome (NTIS) in patients with enterocutaneous fistulas.
  
  
  METHODS
  We prospectively collected 226 patients with enterocutaneous fistulas. Demographics, Acute Physiology and Chronic Health Evaluation II (APACHE II) and Sequential Organ Failure Assessment scores, C-reactive protein, body mass index, albumin, and thyroidal hormones were evaluated for each patient.
  
  
  RESULTS
  The incidence of NTIS was 57.5% in patients with enterocutaneous fistulas. Age and the APACHE II and Sequential Organ Failure Assessment scores were significantly higher, whereas albumin was lower in the NTIS group compared with those in the euthyroid group. A decreased sum activity of deiodinases and a reduced ratio of total thyroxin/free thyroxin and total triiodothyronine/free triiodothyronine were observed in the NTIS group. Patients with NTIS suffered longer durations in the intensive care unit and higher possibilities of mechanical ventilation. The cumulative survival rate was significantly lower in the NTIS group.
  
  
  CONCLUSIONS
  NTIS was common, and patients with NTIS displayed worse clinical outcome and prognosis. A hypodeiodination condition and a potential thyroid hormone-binding dysfunction may play a role in the etiology of NTIS. A low serum albumin concentration and a high APACHE II score were risk factors of NTIS in enterocutaneous fistulas.
authors.affiliation: Department of Surgery, Jinling Hospital, Medical School of Nanjing University, China.
authors.forename: Gang
authors.initials: G
authors.lastname: Han
authors.forename: Jianan
authors.initials: J
authors.lastname: Ren
authors.forename: Song
authors.initials: S
authors.lastname: Liu
authors.forename: Guosheng
authors.initials: G
authors.lastname: Gu
authors.forename: Huajian
authors.initials: H
authors.lastname: Ren
authors.forename: Dongsheng
authors.initials: D
authors.lastname: Yan
authors.forename: Jun
authors.initials: J
authors.lastname: Chen
authors.forename: Gefei
authors.initials: G
authors.lastname: Wang
authors.forename: Bo
authors.initials: B
authors.lastname: Zhou
authors.forename: Xiuwen
authors.initials: X
authors.lastname: Wu
authors.forename: Yujie
authors.initials: Y
authors.lastname: Yuan
authors.forename: Jieshou
authors.initials: J
authors.lastname: Li
mesh_terms: D018806:APACHE; D000328:Adult; D015992:Body Mass Index; D002097:C-Reactive Protein / Q000378:metabolism; D016009:Chi-Square Distribution; D017577:Cutaneous Fistula / Q000150:complications*; D003710:Demography; D005067:Euthyroid Sick Syndromes / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D005260:Female; D006801:Humans; D015994:Incidence; D049528:Insulin, Long-Acting / Q000097:blood; D061386:Insulin, Regular, Human / Q000097:blood; D007412:Intestinal Fistula / Q000150:complications*; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000503:physiopathology; D011379:Prognosis; D011446:Prospective Studies; D012044:Regression Analysis; D012307:Risk Factors; D012709:Serum Albumin; D000075462:Serum Albumin, Human; D015996:Survival Rate; D013963:Thyroid Hormones / Q000097:blood
chemical_list: C499251:Albulin; D049528:Insulin, Long-Acting; D061386:Insulin, Regular, Human; D012709:Serum Albumin; D013963:Thyroid Hormones; D002097:C-Reactive Protein; D000075462:Serum Albumin, Human
keywords: Enterocutaneous fistula; Etiology; Nonthyroidal illness syndrome; Outcomes; Prognosis